Arthritis: Freedom from pain

Arthritis is one of the five leading causes of disability among elderly men and women. The risk for disability from arthritis is as great as that from cardiovascular diseases.

A smooth, slippery, fibrous connective tissue called articular cartilage acts as a protective cushion between bones of a joint. Arthritis develops as the cartilage begins to deteriorate or is lost. In severe cases, when the articular cartilage is gone, the thickened bone ends rubbing against each other and wear away. This could lead to pain, stiffness, swelling, and – at a later stage – deformity.

Arthritis can affect the person at any age and any joint of the body. The most common cause is age-related degeneration known as osteoarthritis, which usually starts at 55-60 years of age. The other common cause is rheumatoid arthritis, which usually affects younger people between the age group of 20-30. In its acute form, arthritis can cripple the person severely. This could affect lifestyle and put constraints on daily activities and job. There could also be trouble participating in everyday personal and family joys and responsibilities. Psychologically, depression, anxiety, and feelings of helplessness could set in.

Neglected disease

As life expectancy is increasing, the number of people suffering from arthritis is also going to increase. Unfortunately, its prevention and early management is neglected by most people. This is entirely due to lack of awareness of the problem and seriousness of the disease in advanced stage.

“India is expected to be the chronic disease capital, with 60 million people with arthritis, by 2025. The government, the private sector, the medical fraternity and NGOs should come together against the onslaught of chronic diseases.” This statement was quoted by Piramal Healthcare Ltd in a nationwide campaign against chronic diseases recently.

Living with a chronic condition like arthritis/rheumatism can affect people emotionally and impact their quality of life. However, there are many ways of coping with these challenges. This year the theme for World Arthritis Day [12th October] is “Think Positive”. This theme acknowledges that the challenges associated with arthritis/rheumatism can get the person down emotionally. But, there are a number of positive things one can do to help one self feel better and get more from life.

There is a need to raise awareness of arthritis in all its forms among the medical community, people with arthritis, and the general public. This is to ensure all people with arthritis and their caregivers are aware of the vast support network available to them. At Dr L H Hiranandani Hospital Powai, Mumbai, there is an Arthritis Support Group – “Joints in Motion”. Once a month, there is a meeting where people suffering or even not suffering from arthritis are invited to spread awareness/knowledge regarding arthritis, its prevention and management. Every person who comes to attend this programme develops a positive view to life. Operated patients with joint replacement interact with those affected with arthritis. This builds confidence and positive attitude towards the needed treatment. This can help millions of patients who suffer acutely and lose hope of becoming well and enjoying life.

Prevention and treatment

The most important aspect of arthritis is prevention. Many factors could help here. The genetic factors and age related degeneration are not under control. Increased body weight, repeated injuries to the joints, lack of exercise and fitness regime and unhealthy eating habits can increase the risk of developing early arthritis. If everyone becomes conscious about these factors then pain, suffering and burden can be reduced to a great extent.

In general, treatment of arthritis depends on the stage of the disease. In the early stage of the disease, physiotherapy or exercises help. Many people with arthritis don’t exercise because they are worried it will increase their pain, or they are unsure what type of exercise to do. But exercise can have enormous benefits for people with arthritis – it can improve joint mobility, strengthen muscles and bones, increase energy levels and general well-being. Regular exercise can not only help your arthritis, general health and well-being, it can also be enjoyable, improve your self-esteem and make you feel more positive about yourself. When a joint is inflamed, you should avoid rapid, jerky movements, bouncing when you are stretching, forcing joints, and high-impact exercises on damaged joints, such as running on hard surfaces or playing squash and doing strengthening/resistance exercises.

Medications and injections in the joints to reduce pain and increase lubrication also have a major role. Varieties of surgical treatments are also available for complete relief of pain. These could vary from arthroscopic lavage – cleaning of inflamed joint, osteotomy – correction of weight bearing angle of the joint, unicompartmental replacement – affected part of joint being changed with artificial joint and total joint replacement. In the advanced stage of arthritis, cure is possible by joint replacement surgery with excellent long term results. Commonly, knee and hip joint can be changed but shoulder and elbow replacement surgeries are also common. There are always many questions in the mind of patients undergoing joint replacement surgery. I would like to arrange these in following order.

Who is a potential candidate for knee or hip replacement?

When pain in the knee or hip severely limits the ability to walk, work or perform even simple activities, a joint replacement may be an excellent option. In some cases, when an individual has the problem in both knees [or both hips], fixing one can reduce the stress on the opposite joint, thus putting off having the second surgery for several years.

What is total knee replacement surgery?

Total knee replacement surgery involves the resurfacing of the knee joint. Metal components are cemented to the ends of the bones and a plastic liner is inserted between them. The knee cap is also resurfaced with a plastic liner. When in place, these components move together to allow normal motion of the knee joint.

What is total hip replacement surgery?

Hip replacement surgery replaces arthritic hip joint with an artificial joint composed of a ball component and a socket component. The metal ball is attached to a stem that fits into the thigh bone. This component can be cemented or non-cemented depending on age and the condition of bone. A plastic liner with an outer metal shell is secured into the pelvis. A combination of a cemented ball and a non-cemented socket also may be used.

How long can patients expect to be hospitalised after surgery?

Hospital stay is five days for total knee replacement as well as total hip replacement. With the new minimally invasive computer assisted procedures being done, I relieve patients out of the hospital sooner, with less pain and a faster overall recovery.

How will the post-operative pain be controlled?

Thanks to advances in medication technology, we are able to keep patients very comfortable after surgery. After surgery, any temporary discomfort does not compare to the pain of arthritis endured by most people in months and years before surgery.

I pay considerable attention to pain management. Post-operative pain will be treated with PCA [patient controlled analgesia] pump by keeping epidural catheter in the back and post operative pain management protocol. Our goal is to manage pain effectively and maximise comfort.

How long does it take to recuperate?

Recovery varies with each person. Generally, patients begin physical therapy the day after surgery. Once home, some patients use a walker for two weeks to protect the new joint while it heals. It usually takes 2-4 weeks to get back behind the wheel. Most people gradually increase their activities during the next 6-8 weeks.

What results can you expect from a joint replacement?

Generally, total joint replacement is successful. Pain is relieved, deformity corrected, and patients resume former activities and enjoy an active lifestyle. Long term success rates vary from 15-20 years, depending on age, weight, and activity level.

How successful is joint replacement?

Both knee and hip joint replacements are recognised as miracles of modern surgery. Most orthopaedic specialists consider it the best way to treat the pain and restore the loss of mobility from severe arthritis. It has allowed thousands of people with arthritis to get back on their feet and resume an active lifestyle.

So, with proper guidance and treatment it is possible to lead a normal life. The most important thing is to reduce the psychological burden of those afflicted with arthritis. So far, no one in the world has died because of arthritis but there is large amount of suffering due to the disease. If one is aware of the facts of arthritis and its management, and has a positive outlook, he or she could be completely free of pain.

I would like this year’s campaign to focus on improving access to psychological support and self-management courses for patients, to help enable people with arthritis/rheumatism to contribute fully to society and lead independent and fulfilled lives. On World Arthritis Day, I request people with arthritis from around the world to come together and make their voices heard to raise awareness about arthritis.